Spiras Health – an emerging home-based care startup – has recently hired two former UnitedHealth Group (NYSE: UNH) executives to join its C-suite team. The hires coincide with a pivotal time in the company’s journey.
Based in Brentwood, Tennessee, Spiras Health provides nurse practitioner-led, at-home clinical care to patients with complex and chronic needs. Not a traditional home care or home health provider, the company focuses on underserved populations in a value-based care context. It believes its unique model enables it do so.
A proprietary “predictive model,” personalized care planning and attention to social determinants of health (SDoH) are all a part of that model. Spiras’ structure supports the patient’s existing medical system, supplementing provider abilities to fill care gaps.
In early June, the company named Ashley White as CFO. White previously served as VP of population health for Lifepoint Health, and before that, spent time at UnitedHealth Group and The Advisory Board.
In January, Spiras hired Nancy Hess as chief commercial officer. On her end, Hess spent 10 years as a VP at Optum, followed by a six-month stint as SVP of growth and strategy at TurningPoint Healthcare Solutions.
While White will be tasked with tackling the “complex issues of value-based care,” Hess will be leading growth strategy and innovation, especially as it relates to Spiras’ work with payers and providers.
“We’re in a sweet spot in the industry, because we have an opportunity to greatly reduce health care costs and positively affect how patients utilize services both inside and outside of the home,” Hess told Home Health Care News. “There’s certainly an opportunity to help patients set and achieve health-related goals fueled by greater education and understanding, which ultimately improves their quality of life.”
In 2021, Spiras Health raised $14 million in a Series B led by Altitude Ventures and FCA Venture Partners. The company helps health plans keep costs down by targeting patients in the home to reduce the incidence of acute events. It utilizes direct hands-on care – including palliative care – as well as telehealth and remote patient monitoring.
Through an identification of members with an elevated probability of “avoidable costs,” Spiras is able to deploy clinicians specifically trained to care for these patients with chronic conditions, intervene and address SDoH concerns before they lead to adverse health outcomes.
“There’s a formula for success that I see Spiras having that some of the other providers of care don’t have in the home,” Hess said. “And that includes addressing social determinants of health, closing these gaps, including addressing the isolation factors that we saw during COVID. There is also the need for the aggregation of services with better coordination of care across providers and other resources available to patients, which [Spiras is doing].”
Spiras Health CEO Scott Bowers also comes from a payer background. Previously, he was the president and CEO of Passport Health Plan and Evolent Health’s national Medicaid president. Before those stops, he also served as the president and CEO of UnitedHealthcare Community Plan of Tennessee.
Spiras’ executives are using their past experiences to inform their future strategy.
Its patient population targets are under Medicare Advantage, managed Medicaid and D-SNP plans. Besides being nurse practitioner-led, its model also utilizes a pod of clinicians focused on delivering individualized patient care.
“We have already achieved significant outcomes that we measure on behalf of the health plans – which include reduced hospitalizations, reduced ER usage, gap closures, smoking cessation program participation and improvements in medication adherence,” Hess said. “We report on those outcomes, impact STARS measure, and measure SDOH outcomes, which positions us uniquely as we identify, treat and close those gaps in the home. And then, we report on those pathways and their positive impact on the patient’s healthcare experience back to the health plan in collaboration with their PCPs and specialists.”
Spiras focuses on patients with polychronic needs, such as COPD, CHF, or diabetes, for example. In addition, it addresses other diagnoses that “you might see with a patient that has severe illness in the home,” according to Hess. And one of the biggest differentiators is its ability to uncover previously undisclosed patient information for the health plans, she said.
The main goal now is further growth and more market differentiation. Moving forward, Spiras is also exploring partnering with providers across the continuum.
